Please fill out the one-page confidential intake form below
1. Download and fill out the form online by clicking the link below. You must click on "enable editing" at the top of the page.
2. Once you have filled it out, select "Save As" and save as a file on your computer
3. Click on the link firstname.lastname@example.org and attach the file.
online injury/condition questionnaire (Fill out only for traumatic injury or acute conditions)
NOTE: If the online forms above don't work for your computer, please print and fill out the PDF document(s) below and bring with you to your appointment.
injury/condition questionnaire PDF (fill out only for traumatic injury or acute conditions)
See the membership agreement below to find out more about my monthly membership. Prices are $75 for a 60-minute session membership, and $115 for a 90-minute session membership: